Cases and Research Letters
Cutaneous B-cell Lymphoma: The Importance of Clinicopathologic Correlation
Linfoma de células B cutáneo: relevancia de la correlación clínico-patológica
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Morell, J. Bassas-Vila, J.L. Mate, I. Bielsa" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Morell" "email" => array:1 [ 0 => "laiamorell@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Bassas-Vila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.L." "apellidos" => "Mate" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "I." "apellidos" => "Bielsa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfoma de células B cutáneo: relevancia de la correlación clínico-patológica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1190 "Ancho" => 1579 "Tamanyo" => 523173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry showed almost equal numbers of B and T cells; the T cells were predominantly CD4<span class="elsevierStyleSup">+</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary cutaneous follicle center lymphoma (FLC) is defined as a malignant proliferation of germinal center cells confined to the skin. It has 3 growth patterns: follicular, diffuse, and mixed. It usually presents clinically as erythematous papules, plaques, and tumors, generally without ulceration, that most often affect the head, the neck, and the trunk. There is, however, a less common variant known as reticulohistiocytoma of the back or Crosti lymphoma that affects the back and consists of plaques and tumors surrounded by macules and papules that extend outward from the tumor.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case with histologic findings that posed a diagnostic challenge and clinical features that were consistent with Crosti lymphoma. The patient was a 53-year-old man who consulted for a back lesion that had grown progressively over the previous 6 years. A previous biopsy performed at another center had shown an infiltrate composed of atypical lymphocytes with positivity for T-cell markers and abundant CD30<span class="elsevierStyleSup">+</span> cells. The suspected diagnosis was mycosis fungoides with CD30<span class="elsevierStyleSup">+</span> cells. No additional immunohistochemical information was available. A staging study consisting of computed tomography (CT) of the chest and abdomen and routine blood tests was normal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed several tumors and plaques surrounded by erythematous macules in the lumbar region and on the left flank (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no signs of organomegaly or lymph node enlargement.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A biopsy performed at our center showed a nodular lymphoid proliferation with a tendency to coalesce extending throughout the dermis and into the hypodermis, with no evidence of epidermotropism (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The lesion was composed of medium and large B cells that were positive for CD20 and CD79 and negative for CD3, CD10, CD23, and CD43; there were also, however, abundant CD3<span class="elsevierStyleSup">+</span>, CD5<span class="elsevierStyleSup">+</span>, and CD7<span class="elsevierStyleSup">+</span> T cells (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Immunostaining was positive for bcl-6 in the large cells and in some of the smaller cells. There was also bcl-2 positivity, but this was difficult to interpret due to the presence of large number of T cells. The cells were negative for CD30, contrasting with the results from the previous biopsy. Approximately 15% of the cells were positive for Ki67. Immunogenotyping revealed clonal rearrangement of immunoglobulin heavy locus (<span class="elsevierStyleItalic">IHG</span>) genes and a lack of T-cell receptor gene (<span class="elsevierStyleItalic">TCR</span>) rearrangement.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On the basis of these findings, we ordered a staging study consisting of general blood tests (including analysis of lactic acid dehydrogenase and β-2 microglobulin levels), a chest and abdomen CT scan, and a bone marrow biopsy. The results were all normal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The main entity considered in the differential diagnosis was marginal zone B-cell lymphoma which, unlike cutaneous FCL, tends to be bcl-6-negative. We also considered diffuse large B-cell lymphoma, leg-type, but this is characterized by a diffuse monomorphous infiltrate with large numbers of large bcl-2<span class="elsevierStyleSup">+</span> and MUM-1<span class="elsevierStyleSup">+</span> cells. Because of the large number of T cells observed, we also initially considered mycosis fungoides and pseudolymphoma, but ruled these out on the basis of the clinical presentation, the type of infiltrate, the presence of <span class="elsevierStyleItalic">IGH</span> clonal rearrangement, and the lack of <span class="elsevierStyleItalic">TCR</span> clonal rearrangement<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (although it should be noted that <span class="elsevierStyleItalic">TCR</span> clonal rearrangement is not always detected in early mycosis fungoides<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>).</p><p id="par0035" class="elsevierStylePara elsevierViewall">On correlating clinical and pathologic findings, Crosti lymphoma was considered the most likely diagnosis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This classic variant of cutaneous FCL is characterized by a B-cell infiltrate with follicle center cells and a variable number of centroblasts that may be accompanied by abundant reactive T cells.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Pan B-cell markers and germinal center markers tend to be positive, but the latter may be negative in FCL with a diffuse growth pattern.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Unlike in follicular lymphoma of nodal origin, cells in Crosti lymphoma are normally not immunoreactive for bcl-2.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6</span></a> Up to 15% of primary cutaneous FCLs, however, express bcl-6 (as was the case with our patient), and this aids diagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Following the recommendations of the European Organisation for Research and Treatment of Cancer,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> we initiated treatment with local radiation therapy. This led to resolution of the lesions and there were no signs of recurrence after 8 months of follow-up.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We have described a case diagnosed as Crosti lymphoma, which is a classic variant of primary cutaneous FCL generally characterized by a diffuse growth pattern and abundant immunoreactive T cells, although diagnosis can be complicated by an absence of germinal center markers.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> In our patient, the main confounding factor was the large T-cell population as this made it difficult to interpret immunohistochemical results and observe tumor cells. The diagnosis was established following a correlation of clinical and pathologic findings.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Morell L, Bassas-Vila J, Mate JL, Bielsa I. Linfoma de células B cutáneo: relevancia de la correlación clínico-patológica. Actas D Dermosifiliogr.2012;103:746-748.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 897 "Ancho" => 951 "Tamanyo" => 162067 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Several tumors and plaques surrounded by erythematous macules in the lumbar region and on the left flank.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1286 "Ancho" => 951 "Tamanyo" => 589442 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The biopsy revealed a lymphoid proliferation with a nodular pattern extending throughout the dermis and into the hyperdermis, with no evidence of epidermotropism.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1190 "Ancho" => 1579 "Tamanyo" => 523173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry showed almost equal numbers of B and T cells; the T cells were predominantly CD4<span class="elsevierStyleSup">+</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous lymphomas: from morphology to chip technology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 16 | 29 |
| 2024 October | 81 | 46 | 127 |
| 2024 September | 87 | 31 | 118 |
| 2024 August | 126 | 87 | 213 |
| 2024 July | 85 | 54 | 139 |
| 2024 June | 99 | 60 | 159 |
| 2024 May | 87 | 59 | 146 |
| 2024 April | 86 | 35 | 121 |
| 2024 March | 89 | 34 | 123 |
| 2024 February | 61 | 35 | 96 |
| 2024 January | 59 | 39 | 98 |
| 2023 December | 72 | 15 | 87 |
| 2023 November | 80 | 32 | 112 |
| 2023 October | 79 | 23 | 102 |
| 2023 September | 76 | 21 | 97 |
| 2023 August | 59 | 20 | 79 |
| 2023 July | 61 | 39 | 100 |
| 2023 June | 63 | 22 | 85 |
| 2023 May | 73 | 20 | 93 |
| 2023 April | 58 | 21 | 79 |
| 2023 March | 59 | 24 | 83 |
| 2023 February | 68 | 23 | 91 |
| 2023 January | 61 | 51 | 112 |
| 2022 December | 57 | 40 | 97 |
| 2022 November | 31 | 30 | 61 |
| 2022 October | 41 | 26 | 67 |
| 2022 September | 47 | 25 | 72 |
| 2022 August | 22 | 38 | 60 |
| 2022 July | 31 | 25 | 56 |
| 2022 June | 41 | 27 | 68 |
| 2022 May | 49 | 40 | 89 |
| 2022 April | 61 | 34 | 95 |
| 2022 March | 43 | 42 | 85 |
| 2022 February | 51 | 25 | 76 |
| 2022 January | 75 | 42 | 117 |
| 2021 December | 43 | 33 | 76 |
| 2021 November | 54 | 53 | 107 |
| 2021 October | 61 | 44 | 105 |
| 2021 September | 62 | 46 | 108 |
| 2021 August | 47 | 28 | 75 |
| 2021 July | 77 | 40 | 117 |
| 2021 June | 29 | 36 | 65 |
| 2021 May | 43 | 35 | 78 |
| 2021 April | 87 | 69 | 156 |
| 2021 March | 62 | 36 | 98 |
| 2021 February | 68 | 20 | 88 |
| 2021 January | 35 | 22 | 57 |
| 2020 December | 33 | 16 | 49 |
| 2020 November | 20 | 24 | 44 |
| 2020 October | 30 | 14 | 44 |
| 2020 September | 43 | 17 | 60 |
| 2020 August | 17 | 16 | 33 |
| 2020 July | 30 | 12 | 42 |
| 2020 June | 53 | 24 | 77 |
| 2020 May | 30 | 18 | 48 |
| 2020 April | 37 | 21 | 58 |
| 2020 March | 44 | 20 | 64 |
| 2020 February | 6 | 10 | 16 |
| 2020 January | 4 | 14 | 18 |
| 2019 December | 4 | 5 | 9 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 0 | 4 | 4 |
| 2019 September | 4 | 7 | 11 |
| 2019 August | 4 | 5 | 9 |
| 2019 July | 4 | 13 | 17 |
| 2019 June | 3 | 15 | 18 |
| 2019 May | 4 | 26 | 30 |
| 2019 April | 2 | 14 | 16 |
| 2019 March | 0 | 12 | 12 |
| 2019 February | 2 | 3 | 5 |
| 2018 December | 4 | 0 | 4 |
| 2018 October | 1 | 0 | 1 |
| 2018 September | 6 | 0 | 6 |
| 2018 February | 51 | 1 | 52 |
| 2018 January | 59 | 6 | 65 |
| 2017 December | 67 | 8 | 75 |
| 2017 November | 39 | 3 | 42 |
| 2017 October | 36 | 4 | 40 |
| 2017 September | 37 | 5 | 42 |
| 2017 August | 56 | 8 | 64 |
| 2017 July | 43 | 4 | 47 |
| 2017 June | 63 | 8 | 71 |
| 2017 May | 61 | 5 | 66 |
| 2017 April | 62 | 8 | 70 |
| 2017 March | 33 | 9 | 42 |
| 2017 February | 30 | 6 | 36 |
| 2017 January | 18 | 11 | 29 |
| 2016 December | 37 | 10 | 47 |
| 2016 November | 46 | 4 | 50 |
| 2016 October | 58 | 8 | 66 |
| 2016 September | 45 | 11 | 56 |
| 2016 August | 40 | 8 | 48 |
| 2016 July | 26 | 12 | 38 |
| 2016 June | 9 | 16 | 25 |
| 2016 May | 6 | 19 | 25 |
| 2016 April | 3 | 1 | 4 |
| 2016 March | 7 | 0 | 7 |
| 2016 February | 8 | 3 | 11 |
| 2016 January | 8 | 2 | 10 |
| 2015 December | 7 | 2 | 9 |
| 2015 November | 25 | 4 | 29 |
| 2015 October | 20 | 7 | 27 |
| 2015 September | 13 | 5 | 18 |
| 2015 August | 8 | 6 | 14 |
| 2015 July | 45 | 9 | 54 |
| 2015 June | 40 | 5 | 45 |
| 2015 May | 56 | 7 | 63 |
| 2015 April | 59 | 9 | 68 |
| 2015 March | 57 | 7 | 64 |
| 2015 February | 51 | 6 | 57 |
| 2015 January | 47 | 15 | 62 |
| 2014 December | 54 | 8 | 62 |
| 2014 November | 45 | 10 | 55 |
| 2014 October | 57 | 14 | 71 |
| 2014 September | 20 | 2 | 22 |
| 2014 August | 28 | 2 | 30 |
| 2014 July | 23 | 2 | 25 |
| 2014 June | 29 | 2 | 31 |
| 2014 May | 42 | 3 | 45 |
| 2014 April | 45 | 3 | 48 |
| 2014 March | 45 | 10 | 55 |
| 2014 February | 33 | 8 | 41 |
| 2014 January | 28 | 5 | 33 |
| 2013 December | 38 | 7 | 45 |
| 2013 November | 23 | 6 | 29 |
| 2013 October | 20 | 5 | 25 |
| 2013 September | 23 | 4 | 27 |
| 2013 August | 29 | 11 | 40 |
| 2013 July | 12 | 19 | 31 |
| 2013 June | 12 | 17 | 29 |
| 2013 May | 12 | 10 | 22 |
| 2013 April | 16 | 10 | 26 |
| 2013 March | 19 | 5 | 24 |
| 2013 February | 39 | 7 | 46 |
| 2013 January | 29 | 4 | 33 |
| 2012 December | 24 | 6 | 30 |
| 2012 November | 1 | 1 | 2 |
| 2012 October | 2 | 4 | 6 |
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